ABSTRACT
Systems of care around vulnerable people are subject to pervasive dynamics of integration and fragmentation, as they address contradictory pressures for positive intervention in a context of dependency. Much has changed in the National Health Service (NHS) over the intervening years, but many of the issues remain disturbingly familiar. In some ways it has been argued that the situation has got worse, “a malignancy of thought” in the provision of long-term care and help for people in later life. Systems theory takes a scientific approach to the proposition that the whole is greater than the sum of its parts. Meaning is found in the connectedness and interdependence of apparently discrete and separate experiences and actions, and therefore of different structures, concepts, and meanings. A system also has a recognizable boundary. This boundary cannot be entirely arbitrary, though it may at times be controversial in what it includes or excludes— much like territorial boundaries.
